Increased thicknesses of the entire retina or specific layers at the fovea did not correlate with functional loss; but a thinner ONL in retinae without foveal pit did. This reduced ONL+ ratio is potentially caused by a reduced foveal cone density and may be the first morphologic functional correlate in prematurity and ROP.

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Aim: Comparison of choroidal thickness (CT) and foveal morphology as seen with swept-source optical coherence tomography (SS-OCT) in children with a history of treated or spontaneously regressed retinopathy of prematurity (tROP or srROP) to assess the impact on best-corrected visual acuity (BCVA). Methods: CT was measured by SS-OCT (DRI-OCT Triton; Topcon, USA) single scans of a 6-mm diameter around the fovea in 17 children with tROP or srROP (4–7 years of age) and compared to 25 controls (age-matched children and adults). The disproportion of the outer nuclear layer and inner retinal layers at the fovea (i.e., the ONL+/IRL ratio) as a measure of macular developmental arrest (MDA) was manually analyzed. BCVA was tested with ETDRS letter charts and correlated with the morphology. Results: CT was significantly thinner in children with tROP and srROP compared to term-born healthy children (nKids) at all measurement marks (p < 0.001), and mostly affected in the subfoveal area. tROP showed the lowest CT. CT allowed no direct conclusion about ONL+/IRL, but correlated positively with BCVA. Conclusions: Reduced CT in children with a history of ROP is linked to ROP severity. These findings overlap with the degree of MDA. CT appears to be involved in ROP, but MDA showed a higher impact on the BCVA of the examined cohort.

Purpose: We correlate dark adaptation course with foveal morphologic alterations in preterm and term-born children using a modified fundus-controlled perimeter and spectral domain-optical coherence tomography (SD-OCT) imaging. Methods: We performed fundus-controlled chromatic dark adaptometry in premature children aged 6 to 13 years without retinopathy of prematurity (no-ROP; n ¼ 61) and with spontaneously regressed ROP (sr-ROP, n ¼ 29), and in 11 age-matched term-born children. The degree of macular developmental arrest (MDA), defined as a disproportion of the outer nuclear layer to inner retinal layers in the fovea (ONLþ/ IRL-ratio), was analyzed with the DiOCTA tool in SD-OCT scans. Results: Children with MDA showed a flatter dark adaptation course progression with a significant rod-mediated sensitivity recovery delay (0.0113 vs. 0.0253 dB/s; P , 0.001). Preterm-born children with regular foveal morphology reached the final rodmediated dark-adapted threshold at 12 minutes after bleach at 18.8 dB, compared to after 18.7 minutes at 17.6 dB in children with MDA (no significant difference in final threshold; P ¼ 0.773). The cone-mediated dark adaptation progression showed a significant lower final threshold in children with MDA (6.0 vs. 8.1 dB; P ¼ 0.004). Conclusions: Changes in dark adaptation were seen in the presence of MDA observed in premature children in the no-ROP and sr-ROP groups. MDA in former premature children is associated with functional deficits of cone and rod photoreceptor visual pathways. Translational Relevance: Morphologic alterations in the central retina of premature children, evident in SD-OCT, are associated with long-term functional deficits in the rod and cone pathways, particularly evident in the rod dark adaptation course measured at 128 eccentricity. This indicates a more widespread retinal functional pathology not limited to the fovea, but occurring together with foveal alterations best defined as MDA.